When I worked in HIV/AIDS, I found that people would shut down when I spoke of HIV as a (then) national issue; it didn’t help when I said it affected millions of sex workers. Today I wonder why the topic of India’s abysmal public health outcomes, even in mainstream sectors such as maternal and child health, has so little saliency with the public. For that matter, I don’t know many people agonizing over multi-drug resistant TB, or open defecation. Why?

At the core is the notion of immediacy. First, people will ask themselves—“Is this an issue that can affect me or my family, directly or indirectly?" If the answer is yes, they may see it as a cause to support—either by raising their voice, volunteering their time, or through funding. Examples of such issues are rising lung disease from air pollution, or location of a landfill near their homes. Recently parents were enraged by the leak of the CBSE examination papers as they felt it would affect the exam results of their children.

Second, the urgency with which people get involved with a personal cause depends on whether they see the problem having effect now, soon, or later. We could think of this set of causes as belonging in a zone of self-interest.

For many other causes, “I don’t really understand it, won’t happen to me, and it may never even happen to my children". To the examples in the opening paragraph, you could add many more “abstract issues" such as climate change, or wildlife conservation. People who look beyond the here and now of self-interest are aware of larger issues—and are willing to take the long view of issues affecting communities, and even the nation—and belong in a zone of altruism. Of course, this is a black and white characterization, deliberately so to emphasize the point that there are two types of giving, and the default is self-interest. Both can and do exist, for many givers.

Indian philanthropy is growing at a healthy 7.96% per annum, according to a Bain and Co. study. I am often told—“There are so many causes out there, but I can’t connect with any of them. What do I do?" There is a way forward for such thoughtful, potential givers. They require studying the documented evidence, and engaging with the grass roots, using the head and allowing the heart.

For the head, this data should be compelling: fewer newborns die in Bangladesh, our economically poorer neighbour; over 30% of Indians are stunted; more than half the Indian population defecates in the open (Bangladesh, again, has solved this problem); and that, according to the Oxford Economics Report, poor sanitation reduces India’s GDP by 5.2%. It wouldn’t be too hard to conclude that our national workforce has been compromised and unless we take urgent action on all fronts, “Make in India" will remain merely a slogan.

However, data doesn’t make an issue personal. When I took a visitor on a field trip to the brothels of Kamathipura in Mumbai, she met Kamla, 22, a sex worker, who was as caring a mother as she was, with all the hopes and aspirations for her son that any other mother would have. She at once felt for this young mother and began to look at HIV prevention more personally. When I took a scientist to a government malnutrition treatment centre in Rajasthan, and he looked into the eyes of a girl of three who was wasting away, he realized with a start that his own daughter was the same age. He appreciated the issue of malnutrition in a uniquely personal way. When someone I knew spoke to a young bride in a village who had to wake up at four in the morning to go to the fields to defecate, she shuddered wondering if she could ever cope in that situation. The issues went from alien to personal, remote to immediate.

Ultimately, it’s all about informed compassion.

Ashok Alexander is founder-director of Antara Foundation. His Twitter handle is @alexander_ashok

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